Obstetric Ultrasound

Scanning Technique

Budi Handono

Divisi Kedokteran Fetomaternal

Fakultas Kedokteran Universitas Padjadjaran
RS. dr.Hasan Sadikin Bandung
Traditional
obstetric
communication
with the fetus
has changed
Probe Types
6 weeks, CRL 4 mm
Machine Controls
 2 & 3 Trimester Scans
nd rd

• Identify fetus
– Orientation
– Fetal heart beat
• Placental site
• Biometry
– Bi-Parietal Diameter (BPD)
– Head Circumference (HC)
– Abdominal Circumference (AC),
– Femur length (FL)
• Liquor Estimation
 2nd & 3rd Trimester Scans
• Place probe longitudinal on lower abdomen
superior to symphysis pubis
• Slide probe superiorly using sweeping
movements to locate fetus
 2 & 3 Trimester Scans
nd rd

• Slide probe superiorly - sweeping side to side

up to uterine fundus.
FH + Orientation
Fetal Orientation
• Lie
– longitudinal
– Transverse
– Oblique
• Presentation
– cephalic
– breech
Cephalic
Breech
Breech legs extended
Transverse lie
 Placental localisation
• Full bladder
• Midline sagittal section
• Placental position anterior or posterior
• Low placenta - measure distance between
lower edge and internal os *
Fundal placenta
Major placenta praevia
Minor placenta praevia
 Liquor volume
• Subjective assessment
• Maximum deepest pool (MPD)
• Amniotic fluid index
Subjective Assessment

Normal liquor volume

 Maximum deepest pool

Deepest pool in cm
Do not include cord or fetal limbs
 Amniotic Fluid Index

Sum of the deepest pools

in each of four quadrants
 Oligohydramnios

MPD < 3 cm up to 36 weeks

MPD < 2 cm 36 weeks - term
Polyhydramnios

MPD > 8 cm
 Fetal Biometry
• Biparietal diameter BPD
• Head circumference HC
• Abdominal circumference AC
• Femur length FL
BPD Measurement

ROCK
Biparietal diameter BPD
 BPD Errors

• Few (best inter-observer error)

• Oblique section (increases measurement)
• Not at BPD (decreases measurement)
 Head Circumference
Trans-ventricular Plane
choroid plexus
anterior horn

posterior horn

CSP
falx cerebri
Trans-ventricular Plane
 Measurement Criteria
BPD & HC

•Landmarks: CSP, Falx, thalami

•Alignment: symmetrical –midline
no orbits, no cerebellum
•Calipers: BPD widest distance 90o
midline.
•HC bony perimeter of skull
 Abdominal Circumference
• Long Axis of fetus (Spine)
• Fetal trunk parallel to transducer
• Rotate transducer at right angles
• Move up and down until landmarks
identified.
• Repeat to consistency
Abdominal Circumference

spine

Ao

UV

stomach
Abdominal Circumference
 AC Sources of Error
• Oblique Section (Salami Effect)
• Too high
• Too low
• Abdominal compression (oligo-
hydramnios)
• Fetal Breathing
 FL Measurement
• Identify femur close to fetal bladder/pelvis.
 FL Measurement
• Slide probe so that femur is central
 FL Measurement

• Rotate probe to obtain full length image of

femur.
Femur Length
 Source of Error

• Oblique image (shortens measurement)